30 y/o male patient medically free before , referred to ER by dermatology as patient having back pain with vesicular rash associated with headache and fever
+ve O/E: he has T38 , conscious, oriented, no rash , and + jolt accentuation test
Admitted as case of meningitis
WHAT IMPORTANT SYMPTOMS IN THE HISTORY THAT SUGGEST MENINGITIS?
Neck stiff ( 31%)
2/4 present in 95% of meningitis cases
HOW SENSITIVE AND SPECIFIC ARE THE MENINGEAL SIGNS ?
jolt accentuation test
BACTERIAL VS VIRAL ?
INDICATION OF CT BEFORE LP ?
VIRAL meninigtis –> within 48h can be PMN after can be Lymphocytic
IgG and IgM in meningitis >> not considered in meninigits workup ,
importnatn in looking for immune status of the patient
5-10 days for IgM to become +ve
14-1 M for IgG to be +ve
Acyclovir only cover Herpes
most common virus is Enterovirus
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